整隻腳發紫、脹痛！搶通深層靜脈栓塞，血管外科醫師圖文解說
蔡承根主任的這篇文章寫得很完整喔，
看完會對深部血管靜脈栓塞有更深入的了解。
Victor Wembanyama’s Deep Vein Thrombosis Shocks Fans, But Spurs Made The Right Call
“When an arm clot spontaneously develops in a young, otherwise healthy individual, particularly a highly conditioned athlete like Wembanyama, it is most often due to subtle but significant anatomic variations of adjacent bones, tendons or muscles. This can cause a condition doctors refer to as thoracic outlet syndrome. These anatomic variations can intermittently compress or pinch the large vein that drains blood from the arm, often at the point it passes under the overlying collarbone (clavicle). Overhead motion can make this process worse, and Wembanyama’s job involves lots of overhead motion to block, rebound and make shots in games and during practice.”
NBA Spur的新星Victor Wembanyama是這次的主角，
近期被診斷出有上肢Deep vein thrombosis，
需要治療和先暫停出賽。
這個疾病在急診常見於下肢，上肢偶爾會遇到，
診斷可以用POCUS快速評估是否有近端的DVT，
最重要的掃描技巧為compression，
如果近端有血栓時，
會導致遠端的靜脈鼓漲無法壓扁。
如果POCUS negative，只能說沒有近端DVT，
如果有遠端DVT的可能，
可以一週內安排門診再行血管超音波的追蹤，
或是考慮安排DVT CT，
有肺栓塞的可能時，就需要立即安排Pumonary embolism的CT檢查。
下肢POCUS建議的三個檢查點為:
Common femoral vein (腹股溝處)
Superficial femoral vein (or called femoral vein) (大腿內側中段)
Popliteal vein (膕窩)
建議姿勢: 平躺，患部腳擺位呈蛙腳狀: 髖外旋 / 膝微彎
探頭: 線形探頭
上肢POCUS建議由:
Brachial vein (上臂中段)
Axillary vein (鎖骨下外側1/3處)
Subclavian vein (鎖骨下中段往外)
建議姿勢: 平躺，患部上肢外展至90度
探頭: 線形探頭
這位46歲男性，左上肢腫兩天，門診轉介
這段影片可見上臂內側中段壓迫下，
brachial vein無法壓扁，
內部也可見到血栓。
開Color Dopple下，brachial vein也幾乎被血栓填滿
在axillary vein和cephalic vein的交會處也可見血栓
Axillary vein的長軸也可見填滿了高回音的血栓
在左側鎖骨上才能掃描到的subclavian vein，
也可看到血栓，而且有不少異常的淋巴結腫大，
推側是跟腫瘤相關，
CT可見到近端的subclavian vein內有血栓
腹部的掃描可見carcinomatosis: omental cake，
因此後續收治給血液腫瘤科去查真正的源頭為何。
